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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423679
Report Date: 02/16/2023
Date Signed: 02/16/2023 01:27:48 PM


Document Has Been Signed on 02/16/2023 01:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:SANTANA, GERALDOFACILITY NUMBER:
013423679
ADMINISTRATOR:SANTANA, GERALDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 527-1652
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 10DATE:
02/16/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Geraldo SantanaTIME COMPLETED:
01:29 PM
NARRATIVE
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On February 16, 2023 at 11:56am Licensing Program Analyst (LPA) Indira Loza met with Licensee Geraldo Santana. There were 10 children and two fingerprint cleared staff present during today's visit.

LPA observed 10 children in care during today's visit. Based on observation and interview it was determined that 7 of the 10 children were infants. This violates the California Code of Regulation 102416.5(d)(1), which is a Type A citation.

See 809-D for the Type A deficiency.

Exit interview conducted. Report and appeal rights provided to Licensee Geraldo Santana.
Notice of Site visit must remain posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 02/16/2023 01:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: SANTANA, GERALDO
FACILITY NUMBER: 013423679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2023
Section Cited

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Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and
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Licensee shall review the regulation, ensure that they have a maximum of four infants in care, and email the LPA a statement stating why the maximum amount of infants is in the regulations by February 17, 2023.
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the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants. This requirement was not met as evidenced by: LPA observed 7 infants in care during the visit which poses an immediate risk to the health and safety to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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